VOL.48 NO.7 lase negative staphylococci, Escherichia coli, Klebsiella spp., Citrobacter freundii, Enterobacter spp., indole-positive Proteus, Serratia

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Transcription:

ceftazidime, cefpirome, cefepime, cefoperazone/sulbactam (2: 1), imipenem Staphylococcus aureus oxacillin coagulase negative staphylococci Escherichia coli piperacillin Klebsiellac spp. Citrobacter Pseudomonas aeruginosa

VOL.48 NO.7 lase negative staphylococci, Escherichia coli, Klebsiella spp., Citrobacter freundii, Enterobacter spp., indole-positive Proteus, Serratia spp., Acinetobacter spp., P. aeruginosa Table 1. The category of MIC value of NCCLS

Fig. 1. Quality control Etest results from 22 facilities. Fig. 2. Categorical accuracy: Etest results of 22 participants for 10 challenge strains against 6 antimicrobial agents.

Table 2. Result of antimicrobial susceptibility testing

6) Ishii Y, Ohno A, Taguchi H, et al.: Cloning and 1) Knothe H, Shah P, Krcmery V, et al.: Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection. 11: 315 ` 317, 1983 2) Knox J R: Extended spectrum and inhibitorresistant TEM-type beta lactamases mutations, specificity, and three dimensional structure. Antimicrob. Agents Chemother. 39: 2593 `2601, 1995 3) Ito H, Arakawa Y, Ohsuka S, et al.: Plasmid mediated dissemination of the metallo- beta lactamase gene blaimp among clinically isolated strains of Serratia marcescens. Antimicrob. Agents Chemother. 39: 824 `829, 1995 4) Livermore D M: Bacterial resistance to carbapenema. Adv. Exp. Med. Biol. 390: 25 `47, 1995 5) Bush K, Jacoby G A, Medeiros A A: A functional classification scheme for beta lactamases and its correlation with molecular structure. Antimicrob. Agents Chemother. 39: 1211 `1233, 1995 sequence of the gene encoding a cefotaximehydrolyzing class A beta lactamase isolated from Escherichia coli. Antimicrob. Agents Chemother. 39: 2269 `2275, 1995 7) Ma L, Ishii Y, Ishiguro M, et al.: Cloning and sequencing of the gene encoding Toho-2, a class A beta lactamase preferentially inhibited by tazobactam. Antimicrob. Agents Chemother. 42: 1181 ` 1186, 1998 8) Arakawa Y, Ohta M, Kido N, et al.: Chromosomal beta lactamase of Klebsiella oxytoca, a new class A enzyme that hydrolyzes broad- spectrum betalactam antibiotics. Antimicrob. Agents Chemother. 33: 63 `70, 1989 9) Hiraoka M, Inoue M, Mitsuhashi S: Hydrolytic rate at low drug concentration as a limiting factor in resistance to newer cephalosporins. Reviews of Infectiuos Diseases. 10: 746 `751, 1988 10) Suzuki Y, Koguchi M, Tanaka S, et al.: Antimicrobial activities of cefepime against clinically isolated strains. Jpn. J. Antibiotics. 48: 1906 `1919, 1995

JULY 2000 Evaluation by Etest of the antimicrobial activity of beta lactam antibiotics against clinical isolates Yoshikazu Ishii, Ling Ma and Keizo Yamaguchi Department of Microbiology, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-0015, Japan A nationwide epidemiological survey of the susceptibility of clinical isolates to beta-lactam antibiotics including cefepime was performed in order to assess the emergence of resistant strains in Japan. Susceptibility to 7 beta-lactam antibiotics, cefepime, cefpirome, ceftazidime, cefoperazone/sulbactam (Cl 5), imipenem, and piperacillin (for gram-negatives) or oxacillin (for gram-positives), was studied in 22 medical centers, using a common protocol and method (Etest; AB BIODISK, Solna, Sweden). Inter-and intra-laboratory variations were evaluated by analysis of quality control strains, and the results demonstrated good reproducibility. No strains resistant to any of these beta-lactams except for ceftazidime were found in Oxacillin-susceptible Staphylococcus aureus or coagulase-negative staphylococci. In Escherichia coli, 14.6% of the clinical strains were resistant to piperacillin, while only 0.5% were resistant to any of the other antibiotics. All clinical strains of Klebsiella spp. and Citrobacter freundii were susceptible to cefepime and imipenem. Isolates of Enterobacter spp. were most susceptible to imipenem (0.5 % resistance) and cefepime (1.0%). Isolates of Serratia spp. were more susceptible to imipenem (4.5% resistance) and cefepime (5.0%) than to the other beta-lactam antibiotics tested. Only 0.5% of indolepositive Proteus were resistant to cefepime and ceftazidime. Isolates of Pseudomonas aeruginosa were more susceptible to cefepime (9.1% resistance) than to ceftazidime (11.4%), CIS (13.7%), piperacillin (20.1%), imipenem (22.4%), or cefpirome (27.9%). These results clearly indicate that emergence of strains resistant to cefepime is less of a problem than for the other beta-lactam antibiotics tested.

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